Stanford researchers: The secret to overcoming the opioid crisis may lie partly in the mind

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ByBeth Darnalland

Emma Seppälä

September 12, 2017

Chronic pain affects an estimated one in three Americans — more than cancer, heart disease, and diabetes combined. This widespread struggle has led to the wide use of pain medications, and a mounting national crisis of opioid addiction and deaths. It’s enough to make you wonder whether there’s a way that we can we help ourselves and our loved ones ease pain safely and effectively without becoming overly dependent on drugs.

The good news is that there is – and it’s well within our grasp.

Most people – including most physicians — think of pain as a physical symptom, but science reveals that emotions also play a big role. In other words – psychology is integral to the pain experience, and it can make it better or worse.

When pain is treated solely with medications, only part of the problem has been addressed. Meanwhile, patients may receive too little of another kind of pain care, one that teaches them self-management techniques for treating pain. Our scientific research in the growing area of pain psychology shows that pain relief is more effective when you address the body and the mind.

Why is the mind’s role so important? We are hardwired to respond to pain as a potential threat to survival (think: escaping a dog attack). The upside of acute pain is that it motivates us to want to do something about it—such as run away—and that can help us survive. But chronic, long-lasting pain has no survival value. After all, you can’t run away from a bad back. The ‘harm alarm’ of pain becomes an ongoing ‘false alarm’ that triggers your stress response: faster breathing and heart rate, racing thoughts and negative emotions. Ironically, these changes can lead to even greater pain. Pain psychology treatment reduces these negative responses, thereby reducing pain.

What happens in the aftermath of surgery helps illustrate how this works. On average, 10 percent of the roughly 200 million surgeries performed each year will result in chronic post-surgical pain, a staggering number. Psychological factors best determine who will recover less well and develop chronic pain. Anxiety and what is known as “pain catastrophizing” –focusing and worrying about the pain excessively—can shape future pain more than the type of surgery or medical intervention. Brain imaging studies reveal that pain catastrophizing keeps the mind focused on pain and distress, alters the structure of the brain, and changes the way the brain functions. Focusing on your fear of the pain increases your brain’s sensitivity to it and makes it feel worse than it should.

For people with chronic pain, it is important to identify negative pain thought patterns, and to learn to stop them in their tracks. The good news is that even someone prone to pain catastrophizing can learn to rewire their brain for pain relief – and it doesn’t have to take long. One study suggests a single-session class can teach people the skills they need to change their brains—and their pain.

At Stanford University, we are testing an online pre-surgical psychological intervention designed to help optimize positive mindset and self-soothing skills before surgery. The goal is to reduce post-surgical pain, distress, and the need for opioids.

Treatments that address the mind – not just the body – are profoundly empowering: you can learn to calm your own nervous system, train your brain away from pain, and deliver self-soothing pain care. These tools can be even more effective than medication with none of the severe health risks or side-effects.

Here are some techniques that you can try right now.

The relaxation response

Relaxing your mind has been scientifically shown to counteract the physiologic effects of pain and stress. This “relaxation response” can be achieved through the following exercises:

Guided relaxation can help you deeply calm mind and body. Download an audiofile like this one onto any smartphone or portable device. Daily use of this mind-body medicine triggers the pain-relieving effects of the parasympathetic nervous system. Over time, your nervous system becomes calmer and you retrain your brain and body away from pain.

OxyContin pills arranged for a photo at a pharmacy in Montpelier, Vt. (AP Photo/Toby Talbot)

Deep breathing exercises like this yoga-based one are ancient relaxation techniques that soothe the nervous system. Research shows that we can quickly lower our blood pressure, heart rate and muscle tension while increasing blood flow through the simple act of respiration. When you experience negative emotions, pain or stress, your breathing rate tenses and becomes rapid and shallow. By changing your breathing, you in turn can change the state of your mind and how you feel. Rather than being caught up in “fight or flight,” you return to a state of “rest and digest.” The body’s warning signals are turned off and your well-being increases. Research we conducted with Iraq and Afghanistan veterans with combat trauma showed that just one week of intensive breathing practices (sudarshan kriya yoga) normalized the veterans’ chronic and intense anxiety – and that these benefits held one month and even one year later.

The Happiness Program offered by the Art of Living Foundation offers evidence-based and comprehensive breathing programs including the Sudarshan Kriya.

Hypnosis for pain is a clinical procedure in which a trained psychologist typically activates a relaxation response. During hypnosis the therapist may guide the patient to visualize pleasurable, safe or comforting scenes and situations. A large survey of 18 hypnosis studies reported that 75% of clinical and experimental participants with different types of pain obtained relief from hypnotic techniques. Another large survey of 20 surgical studies revealed that hypnosis was associated with better surgical outcomes compared to controls.

Meditation is another way to activate your relaxation response. Regular meditation can actually reduce activity in the in the pain regions of your brain while also increasing activity in parts of your brain that help calm your negative emotions. Research we conducted at Stanford University on compassion meditation showed that it reduced negative emotions and chronic pain. Download a meditation app like SATTVA or Mindspace.

Social connection

Pain research confirms that love is analgesic. Pain is felt as less intense in the presence of loved ones, even when simply viewing a photograph of a deeply-loved romantic partner. Such findings underscore the importance of cultivating positive social connections for health and well-being. A recent study showed that when an empathetic partner held the hand of his lover while she was subjected to pain, their heart rates and breathing synced and her pain decreased.

It’s common for people with pain to become socially isolated over time. Social isolation can lead to low mood and worse pain, so find ways to reconnect with friends. Join a free support group from the American Chronic Pain Association. The ACPA and rhe Pain Toolkit provide a wealth of information, pain management resources, and videos to remind you that you are not alone. Sign up to receive a chronic pain daily support text message by texting “WELL” to 444-999.

Cognitive Behavioral Therapy for chronic pain (pain-CBT)

Pain-CBT is considered the gold-standard psychological treatment for chronic pain because it has the best evidence to support its effectiveness across a variety of chronic pain conditions. Pain-CBT is different from traditional therapy or CBT. It is skills-based treatment that educates people about how their thoughts, emotions and stress relate to pain, and then gives them the tools to make it better. These results lead to visible changes in function and structure of the brain, and these changes correlate with patient report of pain relief.

Try biofeedback: Like pain-CBT, biofeedback has evidence to support its benefit for reducing pain across a multitude of pain conditions. Because biofeedback has a physiological emphasis it may be better accepted by patients who otherwise resist psychological treatment for pain. Locate a certified biofeedback therapist here.

More non-drug methods of reducing pain

Get moving: Movement is excellent pain medicine. A physical therapy evaluation can help ensure your movement program right for your pain condition. Also be sure your goals are appropriate for your body today, not the body you used to have. Movement helps improve your mood and sleep, both of which reduce pain.

Make sleep a priority: Poor sleep leads to greater next day pain. Here are a few things we know help boost your sleep: Maintain a regular bedtime every day, turn all electronics off 2 hours before bedtime to reduce your exposure to blue light, refrain from caffeine after noon, engage in relaxing activities before bed (reading, meditation, bath), and journal before sleep.

Take an extended evidence-based course: Cognitive Behavioral Therapy for chronic pain (pain-CBT), Mindfulness Based Stress Reduction (MBSR) and the Chronic Pain Self-Management Program (CPSMP) provide extended support over 6-8 weekly group sessions. Each will help you learn how to harness the power of your parasympathetic nervous system for pain relief. While all three are evidence-based treatments for chronic pain, pain-CBT has the best science backing. You can also work individually with a psychologist who is skilled in treating pain.

Beth Darnall, PhD, is a clinical associate professor in the division of pain medicine at Stanford University. She has more than 15 years’ experience treating adults with chronic pain and lived through her own chronic pain experience. Beth is the author of The Opioid-Free Pain Relief Kit (Bull Publishing, 2016) and Less Pain, Fewer Pills (Bull Publishing, 2014). She lives in Palo Alto, California.

Emma Seppala, PhD, is Science Director of Stanford University’s Center for Compassion and Altruism Research and Education and Co-Director of the Yale College Well-being Program at the Yale Center for Emotional Intelligence. She is author of The Happiness Track (HarperOne, 2016).